高通量透析联合血液灌流在急性重症有机磷农药中毒救治中的临床效果观察

Clinical effect of high flux dialysis combined with hemoperfusion in emergency treatment of acute organophosphorus pesticide poisoning

目的探讨高通量透析联合血液灌流在急诊重症有机磷农药中毒救治中的临床应用疗效。方法选取2017年2月至2019年1月本院急诊科救治的有机磷农药中毒患者132例,按照随机数表法分为观察组(n=72)和对照组(n=60)。观察组给予高通量血液透析联合血液灌流方式进行急诊救治;对照组仅通过应用阿托品和胆碱酯酶复能药物进行急诊处理。观察并比较两组患者治疗过程中清醒时间、住院时间、阿托品用量及不同时间点胆碱酯酶活性水平。结果观察组清醒时间、住院时间短于对照组,阿托品用量低于对照组,差异均有统计学意义(P<0.05)。两组患者不同监测时刻胆碱酯酶活性水平比较差异有统计学意义(P<0.05);两组患者胆碱酯酶活性水平均随时间延长呈逐渐升高趋势(P<0.05)。观察组治疗后3、5、7 d胆碱酯酶活性水平均高于对照组,差异有统计学意义(P<0.05)。结论高通量透析联合血液灌流方式能有效缓解有机磷农药中毒患者的临床症状,加速重症患者清醒,在急诊救治中具有良好的临床效果。

Objective To explore the clinical effect of high flux dialysis combined with hemoperfusion in emergency treatment of severe organophosphorus pesticide poisoning.Methods From February 2017 to January 2019,132 patients with organophosphorus pesticide poisoning treated in Emergency Department of our hospital were selected.And they were divided into observation group(n=72)and control group(n=60)according to random number table method.The patients in the observation group were treated with high flux hemodialysis combined with hemoperfusion,while the patients in the control group were treated with atropine and cholinesterase restorative drugs only.The awakening time,hospitalization time,and the cholinesterase(CHE)activity were observed and compared between the two groups.Results The awakening time and hospitalization time of patients in the observation group were significantly shorter than those in the control group(P<0.05).The dosage of atropine in the observation group was significantly lower than that in the control group(P<0.05).At different time points after treatment,there was statistical difference in the level of indicators at different monitoring time between the two groups(P<0.05).The level of cholinesterase activity in both groups increased gradually with time(P<0.05).After 3,5 and 7 days,the activity level was higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion High flux dialysis combined with hemoperfusion can effectively alleviate the clinical symptoms of patients with organophosphorus pesticide poisoning,accelerate the awakening of severe patients,and have good clinical effect in emergency treatment.